Epidemiology Study On Moderate-Severe Snoring And Obstructive Sleep Apnea Hypopnea Syndrome Of Dirvers Involving Motor Vehicle Accidents

Objective:Snoring is the most common phenomenon in our life. Snoring is due toupper airway anatomical or functional narrow, airflow through the upperairway obstruction, formed a vortex vibration of the soft palate. There is nouniversally accepted, clear definition of snoring. Snoring in American isdefined as “to breathe during sleep with harsh, snorting noises caused byvibration of the soft palate”. In practice, human perception andcategorization of the sound is often the standard. Moderate-severe snoringis defined as intensity louder than talking or very loud, snoring enoughbother other people in the civil. In fact snoring is an important sign of theupper airway narrow, especially in moderate-severe snoring. It is closelyrelated to OSAHS.Obstructive sleep apnea hypopnea syndrome is the most common form ofsleep disordered breathing (SDB) and characterized by repetitive partial orcomplete closure of the upper airway during sleep that leads to louder snoring,frequent awakenings, disrupted sleep, and excessive daytime sleepiness.OSAHS more than just a local phenomenon of upper respiratory tractobstruction. Reserch from other countries estimates that15～20%of accidentsare excessive sleepiness related. The most common disease is OSAHS.Many studys indicated that the risk of MVAs in a driver with untreatedOSAHS ranges from2to7-fold higher than a driver without OSAHS. The riskof MVAs in a driver with moderate-severe snoring is3.4-fold higher than adriver without moderate-severe snoring. Motor vehicle accidents (MVAs) are an important public heath hazard, but few epidemiology studies betweenmoderate-severe snoring and OSAHS, in particular lack of the study of hasoccurred MVAs and moderate-severe snoring in civil. If we clear theprevalence of moderate-severe snoring and OSAHS, and correlation betweenmoderate-severe snoring and traffic accidents, so as soon as possible diagnosisand treatment with the driver suffering from moderate-severe snoring andOSAHS, will be important to reduce traffic accidents. Therefore, weconducted this study.Methods:From September2011to October2012,455drivers who involving motorvehicle accidents were derived from7citys in Hebei province, all qualified tocomplete the questionnaire. The subjects were evaluated using a questionnaireincluding personal information (age, education, smoking, alcohol ingestion，family medical history), sleep apnea, Epworth sleepiness scale (ESS),andhistory of significant MVAs. Measurement of height, weight, neckcircumference and blood pressure by trained physician. All questions wereanswered directly by drivers. Analysis the prevalence of moderate-severesnoring and risk factors. According to the degree of snoring, parts of moderateand severe snores to be tested by protable PSG for whole night and inferredthe prevalence of OSAHS. Based on MVAs the last5years, these drivers weredivided into one accident group and mutiple accidents group using a casecontrol study. Multivariate logistic regression analysis was used to identifyindependent predictors of fatigued and not conscious, to try exploring therelative role of sleep disordered breathing for impaired in traffic safety.Results:1. The general data455subjects were ulltimately for the study. It consisted of all males. Theage range was between19～60years, the average age was36.05±9.17years,BMI(body mass index,BMI)was23.41±2.86kg/m2, neck circumference was38.25±3.75cm, ESS (Epworth sleepiness scale,ESS) was4.11±3.6. Nation:han416(91.43%), others39(3.96%). Education level: college or above 18(3.96%), middle school or high school278(61.1%)，primary school orbelow159(34.94%). Vocation: profession drivers214(47.03%), nonprofession drivers241(52.97%).2. The prevalence of snoringNever Snoring243(53.41%), mild snoring108(23.74%), moderatesnoring71(15.60%), severe snoring33(7.25%). The prevalence of snoring is46.6%, moderate-severe snoring is22.86%.3. The prevalence of OSAHSAmong the104moderate-severe snoring(22.86%),59to be tested byprotable PSG for whole night,31were diagnosed with OSAHS(52.54%), soestimated the prevalence of OSAHS is52.54%×22.86%(prevalence ofmoderate-severe snoring)=12.01%.4. Risk factors of moderate-severe snoringThe drivers involving MVAs who were diagnosed with snoring wereolder, tobacco smoking, alcohol ingestion, obese, with control groups. Thelinear association with a risk for snoring were age (P＜0.001), tobaccosmoking(P＜0.05), alcohol ingestion,BMI (P＜0.001). There were significantdifference in neck circumference(P＜0.05, cut-off:42cm), no significantdifference in family history of snoring(P＞0.05).5. Drivers in MVAs have insufficient awareness on snoringIn all of the drivers surveyed, snoring is not a disease42.64%, snoring isa disease but did not need treated13.41%, needed treated53.52%, alreadytreated0.43%.6. Compare moderate-severe snoring and easily cause of lead to trafficaccidentsmoderate-severe snoring driver is22.86%, the drank driving is18.47%，unfamiliar the way is19.56%，continuous driving more than4hours without abreak is16.7%, did not adopt measures is17.1%, just below not consciousbefore the accident is28.79%and illegal driving is58.68%.7. The correlation between moderate-severe snoring and mutiple MVAsThe incidence of mutiple accidents is30.77%in moderate-severe snoring group，and9.4%in contral group(never snoring and mild snoring). The risk ofMVAs in a driver with moderate-severe snoring is3.4-fold higher than contralgroup (P＜0.001,OR=4.28，95%CI2.472～7.419).8. The correlation between sleepiness and mutiple MVAsThe incidence of mutiple accidents is34.85%in excessive daytimesleepiness group，and10.8%in contral group(without excessive daytimesleepiness). The risk of MVAs in drivers with moderate-severe snoring is4.42-fold higher than contral group (P＜0.001,OR=4.42,95%CI2.428～8.045).9. The correlation between moderate-severe snoring and sleepinessThe incidence of excessive daytime sleepiness is34.62%inmoderate-severe snoring group, and8.5%in contral group (never snoring andmild snoring). Drivers with moderate-severe snoring compared to thosecontrol group were significantly more likely to have excessive daytimesleepiness(P＜0.001).10. Logistic regression analysis of risk factors of sleepinessBackwald multivariate logistic regression analysis was performed usingprogression into fatigue or not conscious as dependent variable and factors ofeasily lead to a traffic accident as independent variables. Multivariate logisticregression analysis of the statistically significant factors showed that:moderate-severe snoring, sleepiness, drank driving, continuous drive morethan4hours without a break, chronic insomnia are an independent risk factor(all P<0.05).Conclusions:1. The prevalence of moderate-severe snoring is22.86%, OSAHS is12.01%in drivers who involving MVAs.2. Increase in age, alcohol ingestion, tobacco smoking, BMI, neckcircumference are associated with a gradual increase in the prevalencce ofOSAHS.3. Moderate-severe snoring drivers is similar to drank driving, whocontinuous drive more than4hours without a break, et al. Moderate-severe snoring is easy to cause excessive daytime sleepiness. Moderate-severesnoring and sleepiness are likely to have mutiple accidents. And that areindependent risk factor of not consious before MVAs.4. Drivers in MVAs have insufficient awareness on snoring, soreinforcing health education to improve public awareness on snoring.